Provider Demographics
NPI:1144850959
Name:INFINITY IMPLANT AND SEDATION DENTISTRY OF MORNINGSIDE LLC
Entity type:Organization
Organization Name:INFINITY IMPLANT AND SEDATION DENTISTRY OF MORNINGSIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIANLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-884-9341
Mailing Address - Street 1:4016 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2459
Mailing Address - Country:US
Mailing Address - Phone:712-239-5812
Mailing Address - Fax:712-239-0662
Practice Address - Street 1:4016 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2459
Practice Address - Country:US
Practice Address - Phone:605-886-8394
Practice Address - Fax:605-886-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental